<form action='<?php echo site_url("/account/register_post")?>' method="post" accept-charset="utf-8">
   <fieldset>
      <label>
         <span class="block input-icon input-icon-right">
         <input name="Email" type="email" class="span12" placeholder="Email" />
         <i class="icon-envelope"></i>
         </span>
      </label>
      <label>
         <span class="block input-icon input-icon-right">
         <input name="Username" type="text" class="span12" placeholder="Username" />
         <i class="icon-user"></i>
         </span>
      </label>
      <label>
         <span class="block input-icon input-icon-right">
         <input name="Password" type="password" class="span12" placeholder="Password" />
         <i class="icon-lock"></i>
         </span>
      </label>
      <label>
         <span class="block input-icon input-icon-right">
         <input type="password" class="span12" placeholder="Repeat password" />
         <i class="icon-retweet"></i>
         </span>
      </label>

      <label>
      <input type="checkbox" />
      <span class="lbl">
      I accept the
      <a href="#">User Agreement</a>
      </span>
      </label>
      <div class="space-24"></div>
      <div class="clearfix">
         <button type="reset" class="width-30 pull-left btn btn-small">
         <i class="icon-refresh"></i>
         Reset
         </button>
         <!--
         <button onclick="return false;" class="width-65 pull-right btn btn-small btn-success">
         -->
         <button type="submit" class="width-65 pull-right btn btn-small btn-success">
         Register
         <i class="icon-arrow-right icon-on-right"></i>
         </button>
      </div>
   </fieldset>
</form>